Harvard Health Ad Watch: A blood thinner winner?

Normally, our blood is designed to clot when necessary to prevent every minor cut or bruise from becoming a life-threatening hemorrhage. A complex system of blood cells, proteins, and blood vessels keeps blood flowing properly and prevents clotting — except in the right time and place. Yet certain health problems sometimes cause blood clots in arteries or veins, which can trigger life-threatening complications. To help treat or prevent abnormal blood clots, doctors may prescribe medicines known as blood thinners.

Quite likely you've seen ads for one such medicine, Eliquis (apixaban), that are popping up everywhere. As is true with most ads for medications, the information presented may be enlightening, but it may also be confusing. And there may be other relevant information that's missing. Let's take a look at one ad that's been in heavy rotation. (This ad only discusses using Eliquis for blood clots in veins that can cause serious complications. It doesn't discuss taking Eliquis for a heart rhythm problem called atrial fibrillation.)

What's around the corner?

A worried woman draped in shadows walks down the block and reaches a corner. As ominous music plays, a voiceover explains: "After my DVT blood clot, I wondered: is another one around the corner?" Now, the music turns light and uplifting. Sun shines down as the voice goes on: "Or could it be different than I thought? I wanted to protect myself. My doctor recommended Eliquis."

The voiceover continues: "Eliquis is proven to treat and help prevent another DVT or PE blood clot. Almost 98% of patients on Eliquis didn't experience another. And Eliquis has significantly less major bleeding than another standard treatment."

The risks of taking Eliquis

Among the information the FDA requires in drug ads is a statement of the most important risks. A serious male voice says, "Eliquis can cause serious and in some cases fatal bleeding. Don't take Eliquis if you have an artificial heart valve or abnormal bleeding." We're also warned about complications that might follow spinal injections, easy or unusual bruising, excessive or prolonged bleeding, and higher risk of bleeding with some medicines. Your doctor needs to know about any planned medical or dental procedures.

Throughout this recital, the visuals are distractingly appealing: a happy couple drives and hikes through breathtaking landscape.

The big finish

The worried woman is clearly in a better place now: "What's around the corner could be surprising. Ask your doctor about Eliquis." As she rounds another corner, she encounters a little girl who is blowing bubbles and runs into her arms. Sweet ending, right?

What to understand about blood clots and blood-thinning medicines

Before considering the pros and cons of this ad, let's talk about why some people need to take medicines like Eliquis in the first place.

Sometimes abnormal blood clots occur in arteries, suddenly interrupting blood flow and triggering heart attack or stroke. Clots can form inside the heart, especially if the heart's rhythm is irregular, as with atrial fibrillation. They may also form in veins (venous thromboembolism, or VTE). Clots in deep leg veins (deep vein thrombosis, or DVT) can travel through the bloodstream to the lungs, causing a life-threatening condition called pulmonary embolus (PE). This may cause shortness of breath, chest pain, and potentially dangerous reductions in blood oxygen levels. Up to 100,000 people in the US die of VTE/PE each year.

For long-term treatment to help avoid initial or recurring blood clots, people take medicines called blood thinners, such as the long-time standard warfarin (Coumadin), or newer options like apixaban (Eliquis).

Warfarin has never been an easy drug to take. It requires frequent monitoring and interacts with many foods and other drugs. The optimal dose can change inexplicably, so people taking warfarin sometimes develop bleeding problems or blood clots, even though their dose hasn't changed.

New blood thinners have become available in recent years. Apixaban (Eliquis) is one of the most popular. And, as is true for most new medicines, it's expensive — it costs nearly $500/month — and heavily promoted.

What the ad gets right

• Oral blood thinners, including Eliquis, are highly effective and routinely recommended after a DVT or PE. Treatment typically lasts at least three months.
• As with all blood thinners, the most common, and potentially serious, side effect of Eliquis is bleeding. Minor bleeding, such as nosebleeds or gum bleeding, is common, occurring in about 10% of people taking it. Major bleeding occurs less than 1% of the time.
• There is some evidence that Eliquis may cause less minor and major bleeding than other, older blood thinners.

What else do you need to know about Eliquis?

• Compared with warfarin, Eliquis requires less monitoring, interacts with fewer medications, and has no dietary restrictions.
• Other options that may be similarly effective include rivaroxaban (Xarelto), edoxaban (Savaysa), dabigatran (Pradaxa), and betrixaban (Bevyxxa). Risks and benefits vary, according to two studies comparing rivaroxaban with apixaban (Eliquis). For example, one study found fewer blood clots and less bleeding with apixaban.
• Blood thinners other than apixaban are recommended for anyone pregnant who is developing a blood clot, or people who have cancer, artificial heart valves, or severe liver or kidney disease.
• Eliquis is also approved by the FDA for atrial fibrillation.

The bottom line

Drug ads are meant to sell a product. While some useful information is included, don't count on ads to be thorough, balanced, or unbiased. You and your doctor should make sure you have the information you need to make a good decision about your medications. Don't leave that up to the makers of Eliquis — or any other drug company.

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